[Multiple peritonsillar abscesses caused by Arcanobacterium haemolyticum in a young female]

A 20-year-old previously healthy woman presented with a four-week history of sore throat and inability to swallow.

Initial examination revealed tender swelling and exudation of both palatine tonsils, trismus and bilateral cervical lymphadenopathy. Laboratory tests showed leukocytosis, elevated C-reactive protein, but unremarkable Epstein-Barr virus titers.

The patient was unsuccessfully treated for three days with topical antiseptics and systemic cefuroxime. Cervical magnetic resonance tomography (MRT) disclosed multiple peritonsillar abscesses. For this reason a bilateral tonsillectomy was performed. Aerobic cultures of the surgical specimens revealed the exclusive presence of Arcanobacterium haemolyticum. The patient's condition improved rapidly after surgery, with continued administration of cefuroxim.

Peritonsillar abscesses are potentially life-threatening complications of a pharyngitis or tonsillitis. Regularly, a mixed microbial flora including Staphylococcus aureus or Streptococcus pyogenes and anaerobic bacteria such as Fusobacterium can be isolated from abscess material. Because of the virulence of the involved microorganisms and the proximity of the jugular vein and the carotid sheath, Lemierre syndrome may develop (throat infection followed by anaerobic septicaemia). Arcanobacterium haemolyticum is responsible for fewer than one percent of all pharyngotonsillitis cases. The infection is clinically indistinguishable from S. pyogenes or Epstein-Barr virus infections. Any removed specimen should be cultured on media supporting growth of fastidious bacteria and under both aerobic and anaerobic conditions. Because of its inconspicuous colony morphology, Arcanobacterium may be wrongly identified as physiological microflora and it is therefore probably underreported as a cause of pharyngotonsillitis and associated complications.